Registered Voters as of May 19, 2013 Democrats:  22,383 Republicans:  14,659 Others: 7,489Total:  44,531

Absentee Ballot Request Form


 
Notice: If you are a Military / Overseas voter or are requesting a Vote By Mail (absentee) Ballot for a Military / Overseas voter, please use the Military / Overseas Vote By Mail (Absentee) Ballot Request Form.

This request is valid for only one (1) registered voter. If you are a qualified and registered voter, ballots will be mailed only for the selected election. Vote By Mail (Absentee) Ballots are mailed approximately 30 days prior to each election to those voters who have requested a Vote By Mail (absentee) Ballot.

VOTE BY MAIL (ABSENTEE) BALLOTS CANNOT BE FORWARDED. If you will not be at your Putnam County address, please complete the MAIL BALLOT TO portion of this form with the address to which you want the ballot mailed. If you are requesting a Vote By Mail (absentee) Ballot for more than one election and will be in a different location for each election, make a separate request for each election with the correct mailing address.

( * Denotes a required field)

* Are you making this request for someone in your immediate family?
 
 
Voter Information:  
* Voter's First Name:
Voter's Middle Initial:
* Voter's Last Name:
* Voter's Date of Birth (mm/dd/yyyy):
* Putnam County Residence Address
(No PO Box):
Voter's Apt, Lot, or Unit Number:
* Voter's City:
* Voter's ZIP Code:
* Voter's Email Address:
Voter's Daytime Phone:
   
Mail Ballot to:  
   
Street, PO Box, Rural Route:
Apartment, Lot, or Unit Number:
City:
State:
ZIP Code:
 
 
You may only request Vote By Mail (absentee) Ballots for yourself and your immediate family, which is defined as your spouse, child, parent, grandparent, sibling, spouse's child, parent, grandparent, sibling, or legal guardian.
If making this request for someone other than yourself, F.S. 101.62 requires you to provide the following information about yourself:
  Requester's Name:
  Requester's Address:


  Requester's Driver's License Number
(if available):
  Requester's Relationship to Voter:
 

Absentee Status:


Vote By Mail (Absentee) Ballots requested: